News Clips
Health Affairs: (9/6) – In this study, researchers found that low-value care and associated spending remain prevalent among commercially insured and MA enrollees. The aggregated prevalence of twenty-three low-value services was 1,920 per 100,000 eligible enrollees, which amounted to $3.7 billion in wasteful expenditures from 2009 to 2019. State-level variation in spending was greater than variation in utilization, and much of the variation in spending was driven by differences in average procedure prices.
Health Affairs: (9/6) – The Comprehensive Primary Care Plus (CPC+), a previous Center for Medicare and Medicaid Innovation (CMMI) model, was a national advanced primary care medical home model that aimed to strengthen primary care through regionally-based multi-payer payment reform and care delivery transformation. In this recent study, researchers found that CPC+ did not improve spending or quality for private-plan enrollees in Michigan, even before accounting for payouts to providers, adding to existing evidence that CPC+ may cost payers money in the short term, without concomitant improvements to care quality.
Forbes: (9/6) – This two-part article addresses the importance of primary care, why investors believe now is the time to bet on primary care, key players, and the future of primary care. While traditionally underinvested, earlier this year researchers found that companies innovating in primary care had raised $16 billion in 2021 alone. Much of the investor enthusiasm is for a new category: “payviders,” who contract with MA plan sponsors or with Medicare directly and receive a fixed fee for all care they provide to a population for a given year. To be successful, the author says these organizations must successfully integrate technology into their practice and patient relationships for the purpose of tightening the very human bonds and further fostering those human connections.
STAT News: (9/6) – In this article, the author reflects on the common themes in response to the MA RFI, which received roughly 4,000 responses. The article outlines three primary buckets of topics covered, including prior authorization, network adequacy, and risk adjustment. The feedback on the MA RFI could influence how CMS approaches regulations for 2024, which will come out in February.
Modern Healthcare: (9/6) – More than 740 health care private equity deals occurred in health care services in the first half of the year, down 20 percent from the same period in 2021 but an increase of 16 percent from 2019. Investors today are increasingly interested in higher-level care services including cardiology, neurology, radiology, and orthopedics. The authors note that any ability to include or have a value-based component around those practices is very attractive to private equity firms.
Modern Healthcare: (9/5) – In this opinion piece, the author offers a physician’s perspective on how providing episodic, fee-for-service care contributes to burnout and suggests that providing value-based (or patient-based) care is a solution. The author notes that value-based care solutions are the first step to recognizing that change is needed and require business and academic leaders, technology solutions, payers and policymakers to be successful.
JAMA: (9/2) – According to this JAMA study, 578 physician practices in dermatology, gastroenterology, and ophthalmology found that acquisition by private equity was associated with increases in health care spending and several measures of utilization, as well as some evidence of greater intensity of care. Taken together, the researchers conclude that these results support the business strategies that private equity firms may pursue in physician practice markets.
Medical Economics: (8/31) – Because of the primary care physician shortage and increased administrative burden that make it more difficult, and costly, for patients to see a primary care doctor, patient behavior is changing. This demand is rapidly changing primary care, driving retailers like CVS and Walmart to get into the primary care game by opening clinics and care being provided by non-physicians, including nurse practitioners and physician assistants. The authors argue that physicians must accept this change and recognize that health care is changing, and old-style hierarchical models are being replaced to put patients, not a single health care profession, at the center of the health care team.
STAT News: (8/31) – Throughout the pandemic, while hospitals received billions in government aid, the pursuit of mergers and acquisitions by the wealthiest health systems continued. Hospitals are continuing to charge higher prices to commercial insurers and Medicare recently granted hospitals the largest price increase since 1998. However, the authors of this article argue that large urban hospitals and wealthy health systems have more than enough money. Employers, employees and taxpayers must demand that those funds be effectively managed to the benefit of the American public by redirecting existing resources and holding the industry accountable for providing high-quality, equitable, and evidence-based care.
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